Site Navigation

Site Mobile Navigation

Putting Profits Before Patients

The inherent conflict of interest in a health care system anchored by for-profit insurers lurks unspoken behind nearly every debate over reform. Few politicians dare to openly address the issue; but over the last year and a half, one unlikely individual has consistently reminded us of this moral dilemma: Wendell Potter.

In articles, interviews and testimony before Congress, Mr. Potter has described the dark underbelly of the health care insurance industry — broken promises of care, canceled coverage of those who fall ill and behind-the-scenes campaigns designed to discredit individuals and snuff out any attempts at reform that might adversely affect profits. And he has the street cred to do so. For 20 years, he was the head of corporate communications at two major insurers, first at Humana and then at Cigna.

Now Mr. Potter has written a fascinating new book, “Deadly Spin” (Bloomsbury, 2010). As I write in today’s Doctor and Patient column, the book details the methods he and his colleagues used to manipulate public opinion and describes his transformation from the idealistic son of working class parents in eastern Tennessee to top insurance company executive, to vocal critic and industry watchdog.

To learn more about “Deadly Spin,” Wendell Potter and the 17-year-old patient whose death affected Mr. Potter so profoundly he left corporate public relations for good, read the full column, “When Insurers Put Profits Between Doctors and Patients,” then please join the discussion below.

I am peripherally involved in the healthcare industry and do see how for-profit companies seek to manipulate physician opinion. In my mind, physician thought leaders need to be carefully vetted and completely open about their ties to companies. It is the physician thought leaders who other physicians follow.

Regarding insurance, why does it remain for-profit? Why would we have allowed such a thing in the first place? I am also confused as to why Republicans want to overturn the healthcare bill.

It boggles my mind that the conflict of interest brought up in this article has not been resolved in our society. Any semi-intelligent person could reason that putting a for-profit industry in charge of something as vital as health care would result in many sad stories of people needlessly suffering and dying in the name of the almighty dollar.

In my medical practice, I encounter many such scenarios where the insurance companies will refuse to pay for tests or procedures, all because of the decisions made by a bean counter with no medical education sitting in a corner office, even if I feel that, as the patient’s personal physician, these procedures would be helpful or even absolutely necessary for the patient’s well being.

Until campaign finance reform is enacted and the lobbying power of the insurance industry is attenuated, we will unfortunately be dealing with the same old same old for years to come.

The liver transplant is only the begninning. Following the transplant are years of expensive medications that the patient must take to prevent her body from rejecting the new liver. Years of medications that would take away from profits and end of year bonuses for insurance company executives.

As a cancer patient 15 years ago, the truth behind our for profit health insurance system became very apparent very quickly. As a medical student in Oregon, I watched the Oregon Health Plan be effectively eviscerated. As a hospitalist and internist, I have lost any hope that our country’s backward, Dickensian health insurance system will ever change. There is simply too much money at stake. And that money is used to buy press and the politicians. It’s only going to get worse. We are turning into something worse than a banana repubilic; we don’t even have bananas to sell.

1. The plan was self-insured and it was my understanding that it was the customer (a public employer no less) that thought the liver transplant should be denied. Not saying the same thing doesn’t happen in other contexts, but this fact appears to have gotten lost — that the “insurer” was spending someone else’s money.

2. One of the best provisions of ACA was to provide a right of external review to avoid the conflict of interest problem, whether the payer is a commercial insurer or the person’s employer.

3. I think Dr. Chen may be understating just how desperate this particular transplant was — my understanding is that Natalyne had already undergone one failed transplant, this was the second, and, as I understand it, her liver was destroyed by treatment for cancer, that had also failed. So the effort was to undertake a second transplant and then find some treatment for the cancer. Maybe I am confusing this with another case, but I don’t think so.

4. UCLA Medical Center basically refused the do the surgery even with the patient on the point of death, and even though the family had raised hundreds of thousands of dollars to guarantee the initial cost of treatment, without a further guarantee of something like a half million dollars (supporting my hunch that UCLA knew just how difficult this case was). This seems especially shocking for a state supported institution.

There is so much wrong with our health care system, from conflicted payers, to greedy ego driven providers, and to the desperate search for desperate cures.

So sorry for the Sarkisians, who really got caught in the middle of all of these forces.

For those free-market conservatives who think that true health care reforms will lead to healthcare rationing, they should understand that insurers are already rationing care on a regular basis. The market has not been able to rationally manage the American health care non-system. It is past time to fundamentally change how we finance health care.

I am a surgeon. If someone needs a life saving surgery then I do it without caring about insurance approval. No hospital executive would succeed in stopping me. You can always appeal the insurance company afterwards. Most of my colleagues act the same as me. I believe the hospital does have some culpability if the events occurred as reported.

I would like to be surprised that NYT has taken so long to acknowledge the merits of this book. Night after night I would read his words making sure I understood whether or not Mr. Potter was simply particpating in a tale of lurid intrigue. I’ve noted him on MSNBC, particularly when the Health Care Bill was self-delusion for the soul. But the book is simply a straight-forward examination of a nation’s corruption at the hands of money and jobs. I’m sorry that Ms. Chen included the bromide regarding the well-meaning employees. I reflected on this sentence many times: medicine should not be practiced by ‘suits’ some thousands of miles from the patient, and the Dantean immorality as put forward by corporations boggles the senses: Health is irreplaceable. You cannot participate in this system, receive a paycheck, and convince me of your good intentions. “Medicos”, like teachers, public employees, librarians, etc. should not harbor fantasies of trumped-up lifestyles: you knowledge and service is THE reward, that should and must be power enough. Mr. Potter deserves America’s thank, and following the next era of Republican gluttony, perhaps he will earn his due. in the meantime, i hope he further elaborates the situation for the uninitiated.

I spent several years in this industry (now in academe) and I have to say I see both sides of this issue. As a clinician, I am appalled at the apparent lack of humanity in both the insurer’s and the hospital’s decision making. I suspect there is more to this case than meets the eye.

The insurer has to make decisions that support the financials of claim costs vs premiums, trying to uncover fraud and misuse of resource, assess a variety of trends in new technology and new disease states. In their best light they measure doctor performance and channel patients to doctors/hospitals with the best outcomes.

In my career I have watched healthcare as a percent of GDP grow from mid single digits to nearly 20% in 2009.
Maybe this country is ready for the tough decisions necessary to make health care affordable for all. Maybe. One decision Britain’s NHS made was to not include technology that costs >$XX per quality-adjusted life year for end of life decisions. (My last read on this was that XX=$60k). As a patient, if you opt out of the system and pay cash for the treatment, you are no longer part of the NHS.
Tough love.

SPM- Thanks for the dedication to the hypocratic oath. I know numerous doctors, physicians, surgeons all of whom would do the same.
Public debate on topics as crucial as our very health care and insurance compensation is healthy. When we STOP talking and haranging…watch out.
I just read a book by a little-known author, Joy Ashe… “Gene Defense: A Genetic Thriller” This story covers the US post the health care reform law in a post 2013 world where Americans are judged by their genes. Sobering plot. It’s fiction…but feasible. I must say this is a worthy read. I found the author site but I noticed it’s on Amazon, too.
Whatever happens on January 12th with the Republican votes, serious long-term implications for all of us remain. I hope they think it through more thoroughly than the Dem-majority- most of whom did not read the bill… “We have to pass the bill to find out what’s in it”… are ya kiddin’ me?

I am certainly no defender of insurance companies, BUT, if you read #8, it appears to me that a girl with failed cancer treatment and a failed liver transplant wanted another liver.

The odds against survival after a failed cancer treatment are poor at best, and if you add a failed liver transplant to that, drop to most likely miniscule. This is probably why both the insurance companiy and hospitals backed away.

Dr. Chen, there certainly are many example of insurance companies shirking their duty, so why did you have to highlight one that really doesn’t make this point?

I don’t believe in evil corporate entities ruining our lives, sorry. There are some bone headed CEO’s out there, but most of them are hard working people who often came from humble beginnings.
Health care has several problems, lack of tort reform, doctors, nurses and other hospital people not adhering to strict cleanliness guidelines and launching deadly infections. Failure of hospitals to buy the right technology to cut down on errors and of course a general obese population that is less and less inclined to get exercise and eat right.
American doctors are the best trained in the world, the insurance companies have brought down costs and covered more and more people.
The fact this guy writes a book with a couple horror stories is more about success in the publishing world, than it is about healthcare.

Let us not forget that the author is a “doctor” and not an uninterested objective party. I was generally offended by the tone of this article. As far as putting their own profit before patients, the exact things could be said about the doctors and the exorbitant rates they charge for the simplest of procedures.

Maybe we should start charging health insurance company executives with reckless homicide whenever a person dies due to some fool in the back room playing dice with their life. Insurance companies are literally deciding who dies – based on greed and profits. Is this not insanity or what?. Even more insane is the fact that some fools – politicians and others – think that this is okay. Oh no, they say, health care reform is “unconstitutional” What might I ask, is “constitutional” about deliberately destroying lives?
.

Amazing that we haven’t thought much about the current German system. Every group, workplace, club, anything to join, has a small health insurance plan, a “Krankenkasse”. Enforced by the German federal government, every citizen has to have insurance, but what seems to work there is that the availability of all these small players spreads the risk pool. Our system, even with employer-mandated plans, which was tried and failed here in Hawai’i, bogs down with bigness, the insurance corporations buying up each other’s risk pools and squeezing out the smaller players, then juggling risk pools to minimize their risks and maximize their profits (and our suffering, or our responsibility for our suffering). That’s what big insurance corps do. Also, the Germans’ plans keep costs lower by staying in line with health expectations; the Krankenkassen pay for everything, naturopaths, massage, yoga classes, preventive things that we could all use before resorting to high tech and high cost, maybe before an malady becomes a serious illness. Maybe the solution is to think about health insurance in such a small local manner and work to limit the size of our insurance corps, spread out the risk pool more. Alas, citizenship is an entirely different concept there, and corporations are not considered above citizens anywhere but here.

#14, jack: did you miss the part where the article said the girl had a 65% chance of living after another transplant?

#10, “If someone needs a life saving surgery then I do it without caring about insurance approval. ” Thank you for saying this. The articles keep talking about how the ins. company denied her…but what about the doctors at her bedside? Did they really just watch her die because someone on the other end of a phone call told them to?? That is horrifying.

And as for the article…I can’t believe that a spy was sent to HER FUNERAL, one of the most sacred events in a family’s life. It just goes to show how utterly disconnected from real humanity some ins. company employees can be. How do they sleep at night? (Let me guess, on 1,000 thread count sheets.)